Office-Based Physical Assessment in Patients Aged 75 Years and Older with Cardiovascular Disease

Abstract

Background: The detection of impaired physical performance in older adults with cardiovascular disease is essential for clinical management and therapeutic decision-making. There is a requirement for an assessment tool that can be used conveniently, rapidly, and securely in clinical practice for screening decreased physical performance. Objective: The present study was performed to evaluate the association of office-based physical assessments with decreased physical performance and to compare the prognostic capability of these assessments in older adults with cardiovascular disease. Methods: A total of 1,040 patients aged 75 years and older with cardiovascular disease were included in this analysis. One-leg standing time (OLST) and handgrip strength were measured as office-based physical assessment tools, and short physical performance battery (SPPB), 6-min walk distance, and usual gait speed were also measured at hospital discharge as measurements of physical performance. All-cause mortality was assessed by death registry at the hospital. We examined the association of office-based measures with physical performance and all-cause mortality. Results: The areas under the curve of OLST for SPPB < 10, 6-min walk distance < 300 m, and usual gait speed < 1.0 m/s were 0.87 (95% CI 0.83–0.91), 0.83 (95% CI 0.80–0.86), and 0.81 (95% CI 0.78–0.85), respectively. The discrimination abilities of OLST for decreased physical performance were significantly higher than those of handgrip strength. After adjusting for the effects of patient characteristics, the hazard ratio for all-cause mortality in the < 3 s group for OLST was 1.68 (95% CI 1.06–2.67, p = 0.03). Handgrip strength, however, was not significantly associated with mortality risk in these participants. Conclusion: Short OLST, in particular < 3 s, is associated with decreased physical performance and elevated mortality risk in elderly patients with cardiovascular disease. OLST can be conveniently measured in the clinician’s office as a screening tool for impaired physical performance.

Predicting non-elective hospital readmission or death using a composite assessment of cognitive impairment and frailty in elderly inpatients with cardiovascular diseases

“…The primary aim of the present study was to assess the utility of a combination developed using the MMSE + CDT and the Fried phenotype for predicting non-elective hospital readmission or death within 6-month in elderly inpatients with CVD. The results of the present study show a strong association between the presence of physical or cognitive frailty and the risk of follow-up, even after controlling for multiple variables (including age, sex, education level, marital status, the presence of DM, HF and previous stroke), which is identical with others results of study [37]. Sensitivity analysis for the association between the MMSE + CDT-SPPB confirmed these results, and it seems to have a higher predictive value for prognosis.…”

Association of affected and non-affected side ability with postoperative outcomes in patients undergoing total hip arthroplasty

“…Additionally, QIS and OLST have the advantage that these can be measured in a small office space, in fact, have proven to be simple to measure from our reports. 25 Therefore, these tests are highly applicable and easily usable in our daily clinical practice. In a report focusing on affected and non-affected side function in patients undergoing THA, Ohmori et al 11 investigated the association between preoperative ability and walking speed 1 year after the surgery.…”

“…Additionally, QIS and OLST have the advantage that these can be measured in a small office space, in fact, have proven to be simple to measure from our reports. 25 Therefore, these tests are highly applicable and easily usable in our daily clinical practice.…”

Calcaneal broadband ultrasound attenuation predicts physical capability: EPIC-Norfolk prospective population-based study

“…Data were collected prospectively, minimising potential for recall bias, with adequate follow-up (at least six years), limiting potential for reverse causality, over a critical period of time in the participants' lives when physical capability typically deteriorates. This highlights the effectiveness of BUA as an early, inexpensive, and non-invasive indicator of physical capability among women, potentially able to indicate risk of numerous outcomes including physical disability [6], sarcopenia [4,11], frailty [12,13] and mortality [5,9].…”

“…Physical capability, a term encompassing a person's ability to perform everyday physical tasks, can be objectively evaluated using tests of gait speed, standing balance and timed chair rises [5]. These highly discriminative physical performance tests are useful markers and predictors of current and future health in older adults [4], with lower physical capability associated with higher risk of disability [6], falls [7], fracture [8] and all-cause mortality [5,9]. Previously, physical Abbreviations: BUA, broadband ultrasound attenuation;; SPS, summary performance score; 2HC, second health check; BMI, body mass index; SD, standard deviation; OR, odds ratio; CI, confidence interval; ADL, activity of daily living; EPIC, European Prospective Investigation into Cancer; CUBA, calcaneal ultrasound broadband attenuation; DEXA, dual energy X-ray absorptiometry; TDI, Townsend Deprivation Index; HRT, hormone replacement therapy.…”